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Blog author, Solai Buchanan is an experienced Registered Dietitian and Certified Diabetes Educator with an MS from Columbia Teachers College. She specializes in treating heart disease, diabetes, hypertension, high cholesterol, polycystic ovarian syndrome,and other chronic diseases. She is a provider at a full-service cardiology practice accepting most insurance and staffed with a primary care MD, pediatrician, and cardiologist. Call: 718.894.7907. NYCC is lead by Interventional Cardiologist Sanjeev Palta, MD, FSCAI, FACC. He trained at Cornell-Columbia Presbyterian Hospital and the State University Hospital of Brooklyn. He currently is an Attending Cardiologist at New York Methodist Hospital and Maimonides Medical Center. He is also an Assistant Clinical Professor in the Department of Medicine at Mount Sinai Medical Center. Having performed over 2000 invasive cardiac procedures Dr. Palta’s patients know they are in trusted hands.

Thursday, December 8, 2016


A new review of existing studies finds that drinking alcohol raises the risk of prostate cancer.  Prostate cancer is the second most common cancer in American men and the second leading cause of cancer deaths in men, preceded only by lung cancer.

When pooling the data of 27 existing studies, researchers found that even having 1-2 drinks a day significantly increases risk of prostate cancer and that as men's alcohol consumption increases, their level of prostate cancer risk also increases.    

Some previous analyses of the relationship between prostate cancer and alcohol consumption were inconclusive.  The researchers of the current study believe this was due to what they call “abstainer bias", the common practice in studies of categorizing former (sometimes heavy) drinkers who quit in the same group as people who never drank alcohol.  This has the result of underestimating the role that alcohol plays in disease.   

Alcohol consumption is an important risk factor for many types of cancer.  A causal relationship exists between alcohol consumption and cancers of the mouth, pharynx, larynx, esophagus, colon-rectum, liver, and female breast; a significant relationship also exists between alcohol consumption and pancreatic cancer, skin cancer, leukemia, and cancers of the cervix, vulva, and vagina. Evidence of exactly how drinking increases the risk of prostate cancer has not been established but researchers believe it may be due to alcohol's genotoxic effects, its role in elevating estrogen levels, and the changes it causes to how the body processes folate.

What to do:  Studies indicate even low levels of alcohol consumption increase prostate and many other cancers so no level of consumption is safe with it comes to cancer.  While moderate alcohol consumption does appear to be mildly cardioprotective, the American Heart Association does not recommend alcohol intake because it increases the risk of "high blood pressure, obesity, stroke, accidents, suicide, and cancer".  It recommends that if you drink alcohol, do so in moderation. This means an average of one to two drinks per day for men and one drink per day for women. A drink is defined as one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits.  Additionally, to help prevent prostate cancer, consume a healthy diet that's lower in meat and total fat and rich in a variety of fruits and vegetables (especially berries, tomatoes, and cruciferous vegetables such as cabbage and broccoli), beans and legumes, and omega-3 rich fish such as salmon.   

Adapted from articles available at:

Zhao J, Stockwell T, Roemer A, Chikritzhs T.  Is alcohol consumption a risk factor for prostate cancer? A systematic review and meta–analysis.  BMC Cancer 2016 16:845.  Published online 15 November 2016.  DOI: 10.1186/s12885-016-2891-z

Tuesday, November 29, 2016


The evidence on the importance of sleep to our long-term health and well-being has never been stronger.  Inadequate sleep, shift work schedules, and sleep disorders such as obstructive sleep apnea and insomnia have all been found to be significant risk factors for chronic diseases including heart disease, diabetes, depression, and even dementia.  The Center for Disease Control estimates nearly one-third of Americans are habitually sleep-deprived and this percentage is expected to continue to increase.  Not only is the quantity of our sleep inadequate but the quality of our sleep is also trending down.  One of the growing threats to the quality of our sleep is likely lurking right beside your pillow as you sleep – your smartphone.  A growing body of research indicates using electronics such as smartphones, tablets, e-readers and other back-lit devices, especially before bed, makes it more difficult to fall asleep and decreases the quality of the sleep we do get. 

The results from a recent month-long study are illustrative of the negative impact these devices are exerting on our sleep.  In this study, 650 adults used an app that tracked their smartphone use as well as the duration and quality of their sleep.  Researchers found the more individuals used their phones, especially in the hours before bed, the less they slept and the poorer quality of their sleep.   

Why are these devices bad for our sleep?  Not only do they occupy us when we should be sleeping but they emit short wave-length blue light that suppresses our production of melatonin, the hormone that helps us fall asleep. 

What to do:  To prime your circadian rhythm and counter the effects of screens at night, it helps to expose yourself to lots of bright light during the day.  Then, at night, if you have problems falling or staying asleep, try to avoid looking at bright screens, particularly those held close to your eyes, beginning 2-3 hours before bed.  It is especially crucial to avoid screens during the hour leading up to sleep.  Red light has the least power to shift circadian rhythm and suppress melatonin.  If you must use devices close to bedtime, utilizing special glasses that filter out the blue/green wavelength or employing apps (such as “Twilight”) or built-in phone settings (such as iPhones’ “night shift” setting) that shift the display from blues to warmer tones at night may help to encourage your body’s natural sleep/wake cycle. 

Information adapted from articles available at:

Christensen MA, Bettencourt L, Kaye L et al.  Direct measurements of smartphone screen-time: relationships with demographics and sleep.  PLOS ONE, 2016;11(11): e0165331. DOI: 10.1371/journal.pone.0165331

Thursday, November 17, 2016


A new analysis of existing studies concludes that when we get inadequate sleep, we tend to overeat on the following day.  Researchers pooled the results of 11 sleep and intake studies that included 172 participants.  The study designs varied, but they all tested people after a night of restricted sleep, usually about four hours, and then after a night of normal rest.

On the day after sleep-deprived and sleep-adequate nights,  participants were offered a breakfast buffet or scheduled meals later in the day. The scientists recorded calorie intake and tracked energy expenditure with heart rate monitors and other electronic devices.  They found that after a night of limited sleep, people consumed an average of 385 extra calories the next day, roughly the equivalent of a frosted cupcake or a serving of fries. They also consumed more fat and less protein.  While sleep deprivation increased intake, the amount of energy individuals burned was similar after restful and sleep-deprived nights.

Why does inadequate sleep lead to extra calorie intake?  Some research indicates sleep deprivation impacts the hormones that control appetite.  There is also evidence that a lack of  sleep heightens the desire to seek food as a reward.  For example, a 2013 report found that the brains of sleep-deprived people responded more urgently to pictures of fattening food, inspiring cravings even when the participants were full. At the same time, the sleep deprived brains experienced a drop in activity in the region of the brain associated with careful decision-making, indicating an increased propensity to yield to cravings.

What to do:  Feed your body right by sleeping 8 hours a night or as close to that as possible.  Also, on days following nights that had too little sleep, try to be especially deliberate about your food choices by planning ahead and making a point of avoiding situations that might trigger unhealthy choices.  Help protect against increased hunger by maximizing satiety with extra water, adequate lean protein, and fiber-rich food choices.

Al Khatib HK, Harding SV, Darzi & Pot GK.  The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis.  European Journal of Clinical Nutrition.  Published online in advance of publication 2 November 2016.  DOI: 10.1038/ejcn.2016.201

Adapted from articles available at:

Saturday, October 29, 2016


Want to control or prevent diabetes?  Regular physical activity is key and the evidence supporting this fact has never been stronger.  Two recent reports illustrate how regular physical activity is an instrumental part of better blood sugar control.  And, compelling findings on the importance of breaking up sedentary time and doing short stints of activity throughout the day has prompted to the American Diabetes Association (ADA) to release new activity recommendations for diabetics.  The ADA advises diabetics break up sedentary time by doing 3-minute or longer bouts of activity every half hour rather than every 90 minutes as had been previously recommended. 

While regular physical activity is a cornerstone in prevention and management of type 2 diabetes,  the relationship between time spent doing activity and diabetes risk reduction has not been clearly quantified.  A recent meta-analysis examined the existing studies on the relationship between physical activity and the incidence of diabetes.  These studies included over 1.2 million subjects.  The analysis found a clear dose response relationship between activity and diabetes risk prevention and the relationship held over a broad range of activity levels.  Even doing as little as 5 minutes of activity many times a week offers some benefit.  The recommended 150 minutes per week of moderate cardio (such as 30 minutes of brisk walking five times per week) reduces the risk of diabetes by 26%.  And, exceeding recommendations has additional risk reduction benefit.  Doing more than 300 minutes per week resulted in a more than 50% reduction in diabetes risk.

Another recent trial investigated the blood sugar control benefits of exercising for short bouts after meals versus exercising for a longer period once per day.  In the study, for 14 days each, 41 adults (aged 18-75) with type 2 diabetes either walked 30 minutes daily or walked for 10 minutes after breakfast, lunch, and dinner.  Fasting blood samples, weight, height and waist size were taken on days 1 and 14.  Participants wore accelerometers to track activity, completed food journals to track intake, and wore continuous glucose-monitoring systems to gather blood sugar information. Overall it was found that after meal blood sugar was an average of 12% lower during the "post-meal walking intervention" part of the study than when following the "30 minutes of daily activity" intervention.  Interestingly, researchers found a marked 22% reduction in blood sugar following the walk after the evening meal.  Adding in walking in the evening produced more significant changes because participants tended to be mostly sedentary in the evening and the dinner meal tended to contain the largest portions of carbs and starches.
Also, this week the ADA announced recommendations that persons with diabetes, in addition to doing regular structured activity,  should do three or more minutes of light activity every 30 minutes when engaged in prolonged periods of sitting, such as working on a computer or watching television.  Previously, they had recommended doing a few minutes of light activity at least every 90 minutes during sedentary time but when the ADA reviewed over 180 studies on the topic, researchers found significant blood sugar control and circulatory benefits to breaking up sedentary time even more.  Examples of suggested light activities include overhead arm stretches, walking in place, leg lifts or extensions, desk chair swivels, torso twists, and side lunges.

What to do:  Whether you have diabetes or not, do regular cardiovascular activity.  To prevent and control diabetes, aim for at least 30 minutes of activity on most days and if you can do more, the additional activity yields meaningful benefit in diabetes prevention and control.  Doing activity after meals, especially the dinner meal, and adding in brief periods of activity every 30 minutes when sedentary will further benefit your blood sugar control and circulatory health.

Information adapted from articles available at:

Smith AD et al. Physical activity and incident type 2 diabetes mellitus: a systematic review and dose–response meta-analysis of prospective cohort studies.  Diabetologia; 2016.   DOI: 10.1007/s00125-016-4079-0

Reynolds AN et al. Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study. Diabetologia; 2016. DOI:  10.1007/s00125-016-4085-2 

American Diabetes Association Press Release, October 25, 2016.  http://www.diabetes.org/newsroom/press-releases/2016/ada-issues-new-recommendations-on-physical-activity-and-exercise.html?referrer=https://www.google.com/

Thursday, September 29, 2016


Stress is known to be an independent risk factor for many chronic diseases including heart disease and diabetes.   An interesting new study indicates that one of the ways stress impacts health is by diminishing the positive effects of healthy foods. 

To evaluate the interactions between diet and stress, researchers recruited 58 healthy women with an average age of 53.  On two different days, participants consumed a high fat breakfast of biscuits and gravy.  Both days the breakfasts contained 930 calories and 60 grams of fat but on one day the fat came from unhealthy saturated fats and, on the other day, the fat came from healthy monounsaturated fat.  On both occasions the women completed detailed interviews to assess the stress they experienced on the previous day.  Their blood was drawn multiple times during their visits. The researchers looked at two markers of inflammation -- C-reactive protein and serum amyloid A. They also evaluated two markers of cell adhesion molecules, indicators of how readily arterial plaques form.   The research team controlled for blood levels before the meals, age differences, abdominal fat and physical activity -- all factors that could impact the physiological response to the meal.

Previous research has shown that saturated fats increase inflammation in the body, which has been linked with heart disease, type 2 diabetes, and a host of other chronic health problems.  Saturated fats mainly come from the fats in dairy and meat.  Conversely, monounsaturated fats such as those found in olives and nuts are associated with lower levels of inflammation and better heart health.

The trial found that participants with low recent stress levels exhibited lower levels of inflammation and cell adhesion after they ate the monounsaturated fat biscuits and gravy, compared with when they ate the saturated fat-laden alternative.  But, for participants with higher levels of recent stress, the monounsaturated fat meal did not confer physiological advantages.  Their levels of inflammation and cell adhesion were comparable to when they had the high saturated fat meal. 

These findings add to the evidence that stress, even moderate, short-term stress exerts a powerful role on our health. Exactly how stress interacts with the physiological effects of foods is not known.  It is possible that the harmful effects of stress overwhelm the potential benefits of a healthy meal, or it may be that stress itself alters the body's processing of the meal.  Other studies have shown that a person's metabolic rate is lower and insulin levels are higher following a stressful day.

What to do:  Because food is tangible and stress is not, it is sometimes harder to recognize an unhealthy stress response than an unhealthy food.  These results underscore the importance of developing healthy strategies to cope with stress and they hint at the fact that in order for us to realize the full benefits of a healthy diet, we must first manage our stress.  Regular sleep, regular physical activity, journaling, talking with others, practicing mindfulness, and cognitive behavioral therapy can all help to support better stress management. 

Kiecolt-Glaser JK, Fagundes CP, Andridge C et al. Depression, daily stressors and inflammatory responses to high-fat meals: when stress overrides healthier food choices. Molecular Psychiatry, 2016. DOI: 10.1038/mp.2016.149

Information adapted from articles available at:


Tuesday, September 27, 2016


A new analysis suggests that eating two or more servings per week of fatty fish such as salmon can significantly reduce diabetics’ risk of retinopathy.  Diabetic retinopathy develops when elevated blood sugar levels damage the tiny blood vessels in the retina.  It is estimated more than 80% of patients with type 2 diabetes will develop some form of diabetic retinopathy within 20 years of diagnosis. 

The current findings were drawn from a five-year Spanish study that tracked the dietary intake and health of participants (ages 55-80) with type 2 diabetes.  They found that those who routinely had fatty fish twice per week were 48% less likely to develop diabetic retinopathy than those who consumed less.

Why might intake of fatty fish be protective of eye health?  Omega 3 fatty acids are found in high concentrations in the eye where they are believed to help protect against oxidative damage caused by elevated sugar levels, systemic inflammation, and age-related changes.  While it is believed that the omega 3 fatty acids are the constituents in fish that promote eye health, studies in which individuals supplemented with fish oil rather than eating the whole fish have not yielded as positive results.  This may be due to benefits from other nutrients in the fish as well as the fact that the omega 3’s found in foods are fresher and less degraded than the oils extracted for supplements.

What to do:  To minimize the damage caused by diabetic eye disease, the most important measure is to control your blood sugar.    Controlling blood pressure is also important for eye health.  Fatty fish include salmon, mackerel, sardines, tuna, and rainbow trout.  Regular intake of fatty fish is not only is good for the eyes but also the other systems of the body, especially the cardiovascular and neural systems.  The amount of fish eaten in this study provided about 500mg daily of omega-3 fatty acids but do not supplement with fish oil without consulting your provider.  

Article adapted from:


Sala-Vila A, Díaz-López A, Valls-Pedret C, et al. Dietary marine ω-3 fatty acids and incident sight-threatening retinopathy in middle-aged and older individuals with type 2 diabetes: Prospective investigation from the PREDIMED Trial. JAMA Ophthalmology. Published online August 18, 2016. DOI:10.1001/jamaophthalmol.2016.2906

Larsen, M.  Eat your fish or go for nuts.  JAMA Ophthalmology.  Published online August 18, 2016. DOI:10.1001/jamaophthalmol.2016.2942

Saturday, August 20, 2016


Gout is a painful arthritis that develops when uric acid crystals deposit in the joints.  A new analysis indicates that following the Dietary Approaches to Stop Hypertension (DASH) diet plan can significantly improve gout by lowering elevated blood levels of uric acid.

The findings stem from a new analysis of the data collected in the original DASH diet randomized clinical trials conducted in the '90's.  The DASH diet emphasizes intake of vegetables, fruits, and fat-free/low-fat dairy products and includes healthy amounts of whole grains, fish, poultry, beans, nuts, and vegetable oils while limiting salt, sweets, sugary beverages, and red meats.  Nutritionally, this means DASH is low in sodium and unhealthy saturated fats while being rich in fiber and the blood pressure-friendly minerals potassium, calcium, and magnesium.  The landmark DASH trial reported in '97 revealed following the DASH diet markedly improves blood pressure in hypertensive persons. Now, an analysis of the original DASH study participants' blood uric acid levels reveals the diet also substantially reduces uric acid in the blood.  Impressively, among study participants with elevated uric acid levels, DASH lowered levels by nearly as much as typical gout medication treatment.

The underlying causes of gout remain poorly understood.  Alcohol intake (especially beer), meat intake, diabetes, high blood pressure, obesity, sickle-cell anemia, kidney disease, and diuretic medications are some of the known risk factors for gout.  Gout sufferers are advised to reduce their intake of proteins rich in purine which raises uric acid levels.  One reason DASH is likely good for gout is that it emphasizes lean dairy and plant-based proteins from beans that are naturally lower in purine than meat, fish, and chicken.  It is also believed that gout sufferers' benefit from the variety of anti-inflammatory phytonutrients found in the plentiful fruits and vegetables of the DASH diet.

What to do: If you suffer from gout eliminate alcohol and actively hydrate, drinking 8-16 cups of water daily.  Moderate your intake of meat, shellfish and other animal proteins, and instead get more of your protein from lean dairy, eggs, and beans.  And, given the promising results of this analysis, take steps to adopt the DASH diet.  Detailed information on the diet and meal plans are available online at:  www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf

Juraschek SP, Gelber AC, Choi HK, et al.  Effects of the Dietary Approaches to Stop Hypertension (DASH) diet and sodium intake on serum uric acid.  Arthritis & Rheumatology.  Published online August 15, 2016. DOI: 10.1002/art.39813

Adapted from articles available at:

Thursday, July 21, 2016


The National Health and Nutrition Examination Survey (NHANES) conducts detailed surveys and physical examinations on a nationally representative sample of approximately 5,000 individuals each year.  It is one the primary ways in which the Center for Disease Control and Prevention tracks the health and nutritional status of Americans.  A recent analysis of adults in NHANES from 2009-12 uncovered an intriguing association between poor hydration status and excess weight.   

For the study, researchers assessed adults ages 18-64, noting height, weight, and urine osmolality.  Results indicated nearly one-third of participants were inadequately hydrated and those who were inadequately hydrated were 1.6 times more likely to be obese, even after they controlled for factors known to effect hydration status.  So, these result clearly indicate a link between obesity and insufficient hydration but it is unclear if there is a causal relationship.  Certainly, people with obesity need more water than people who have smaller bodies, making the hydration threshold potentially harder to reach.  It is also possible that people at higher weights are less likely to practice behaviors that support hydration such as eating fresh fruits and vegetables (which significantly contribute to our fluid intake - a medium  cucumber, for example, contains over 1 cup of water).  Alternatively, poor fluid status may be a contributing factor to obesity.  For example, if an individual tends to eat when they are actually thirsty, they would be more likely to gain weight.  Certainly, there is evidence that overweight/obese persons who drink water before meals lose more weight those who do not.  

What to do:  Whether or not inadequate hydration is a driver of excess weight, maintaining proper hydration is essential to our health.  Even modest dehydration has been found to contribute to problems such as kidney stones, constipation, urinary infections, and headaches.  Mild dehydration has also been shown to decrease mood and depress psychomotor and attention/memory skills.  So, how can you tell if you’re drinking enough fluids? The Institute of Medicine recommends men get 125 ounces (~15 1/2 cups) of fluid from all food and beverages consumed daily while women need 91 ounces (~11.5 cups).  But fluid needs vary considerably depending on individual characteristics as well as weather conditions and activity level.  The most reliable way to tell if you are adequately hydrated is to check the color of your urine. If it is light, almost the color of water, then you likely getting enough.  Avoid high calorie drink choices like soda, juice, and other sweetened drinks.  If you are not a fan of plain old water try seltzer, herbal tea, or flavoring water with lemon, lime, orange, mint, or cucumber.

Chang T, Ravi N, Plegue MA, Sonneville KA, & Davis MM.  Inadequate dydration, BMI, and obesity among US adults: NHANES 2009-2012. The Annals of Family Medicine, 2016; 14 (4): 320. DOI:10.1370/afm.1951

Information adapted from articles available at:

Thursday, July 14, 2016


Diets low in sodium and rich in potassium, calcium, and magnesium are associated with healthier blood pressure levels.  These minerals play a pivotal role in the body's regulation of fluid and the function of the arterial muscles.  Still, experimental trials with supplementation have yielded mixed results, but a recent meta-analysis strengthens the case for magnesium's blood pressure benefits. Researchers pooled data from 34 magnesium supplementation clinical trials with a total of 2,028 participants, to find a small but significant association between magnesium intake and reduced blood pressure, particularly in those individuals whose diet is inadequate in magnesium.

Combining the findings of the different trials revealed that taking about 368 mg of magnesium daily for about three months resulted in overall reductions in systolic blood pressure (the top number in a reading) of 2 millimeters of mercury (mm/Hg) and diastolic blood pressure (the bottom number) of 1.78 mm/Hg.  The effect of supplementation was more pronounced in individuals with inadequate dietary magnesium sources. 

What to do:  These findings underscore the importance of consuming a healthy diet rich magnesium.   The U.S. Recommended Dietary Allowance for magnesium is 310-320 milligrams per day for women and 400-420 mg per day for men.   While a balanced diet rich in plant foods is plentiful in magnesium, it is estimated that 60-80% of Americans do not get adequate dietary magnesium.  Excellent sources include whole grains, beans, nuts and dark green leafy vegetables.  If you feel your diet might be lacking discuss supplementation with your provider.  Do not supplement with high doses of magnesium as it can cause GI symptoms, and impede absorption of other minerals or medications.   Magnesium aspartate, citrate, lactate, and chloride forms of the supplement are better absorbed than magnesium oxide or sulfate. 


Zhang X, Li Y, Gobbo LCD, et al.  Effects of magnesium supplementation on blood pressure: a meta-analysis of randomized double-blind placebo-controlled trials.  Hypertension2016. Published online ahead of print July 11 2016, DOI :10.1161/HYPERTENSIONAHA.116.07664

Information adapted from articles available at:

Tuesday, June 21, 2016


The essential mineral copper has been gaining increasing attention over the past decade for its role in human physiology.  Copper is needed to form red blood cells, absorb iron, develop connective tissue, mediate neural communications and support the immune system.  A new study in mice suggests that copper has another important function – enabling the breakdown of fat stores.

The researchers made the copper-fat link using mice with a genetic mutation that causes the accumulation of copper in the liver. The inherited condition, known as Wilson's disease, also occurs in humans and is potentially fatal if left untreated.  The researchers noted that, compared to the controls, the mice with Wilson’s had lower liver fat stores and greater body fat stores.  The researchers also found that the fat tissue in the bodies of the mice with Wilson's had lower levels of copper compared with the control mice.  When researchers treated the Wilson's disease and control mice with isoproterenol, a substance known to induce the breakdown of fat, they found that the mice with Wilson’s exhibited less fat-breakdown than the control mice.  

Next, working with cell cultures, the researchers sought to clarify the mechanism by which copper influences the breakdown of fat.  They found that copper deactivates one of the enzymes that stops the process of fat breakdown.  This study was the first to uncover the biochemical mechanisms linking copper and fat but not the first to indicate some sort of relationship between copper and fat stores.  Previous work with beef cattle has found that higher levels of copper in feed creates meat cuts with lower fat content. 

What to do: It remains to be seen exactly what role copper plays in human fat breakdown.  The adult Recommended Daily Allowance (RDA) of copper is 900 mcg.  The U.S.  Food and Nutrition Board estimates that only 25% of the U.S. population gets enough copper daily.  Still, limit any supplementation to no more than 100% of the RDA as excessive copper intake can impair absorption of other key minerals such as zinc.  The best way to ensure you have adequate copper levels is to consume a variety of foods rich in copper including oysters and other shellfish, wheat bran, leafy greens, mushrooms, seeds, nuts, cocoa products, and beans.

Krishnamoorthy L, Cotruvo JA, Chan J et al.  Copper regulates cyclic-AMP-dependent lipolysis.  Nature Chemical Biology.  Available online June 6, 2016 ahead of print. DOI: 10.1038/nchembio.2098

Adapted from articles available at:



Weight loss, even just 5-7% of bodyweight has been shown to substantially improve heart health risk factors including high blood pressure, high cholesterol, sleep apnea, and insulin resistance/elevated blood sugar.  But, weight loss is notoriously hard to maintain.  A recent study of participants from a season on the “Biggest Loser” presented some disheartening findings.  The report found that six years after dropping an average of 129 lbs., participants had regained 70% of lost weight and their bodies were burning about 500 fewer calories a day than other people their age and size.  This report underscores just how difficult it is to maintain weight loss.  Still, many people do achieve significant weight loss and manage to keep it off.  The National Weight Control Registry (NWCR) is a database of more than 10,000 persons who have lost more than 30 lbs. and have kept it off for more than 1 year.  Investigations of these individuals reveal that maintaining weight loss is an active process requiring just as much focus as weight loss.  Let’s identify the actions that are essential to keeping weight off.   

Alter your mind-set

The key to maintenance is to accept that the changes made in one’s lifestyle during weight loss must be kept up during maintenance.  Choosing healthier foods, taking home half your restaurant meal, lacing up your sneakers for a walk – it is all about making and repeatedly practicing healthier behaviors until they become your new way of living.  It is also important to have a relapse prevention plan and implement it when your weight starts to creep up.  Slip-ups are a normal part of life but preventing slides and getting back on track is essential for effective weight loss maintenance.  Proactively coping with setbacks appears to be another strength of NWCR participants

Tweak rather than overhaul what you eat

When losing and subsequently maintaining weight loss, follow a plan that is not radically different from your “normal” patterns but just different enough that it supports effective weight management.  For example, while people on average lose weight more quickly on very low carb diets such as Atkins, these intake patterns are rarely adopted long-term.  When the diet is abandoned, the carbs come back in and so does the weight.  Instead of eliminating carbohydrates, moderate them.  In general, choose a weight loss plan that incorporates a variety of whole foods, including fruits, vegetables, whole grains, beans, nuts, lean sources of protein, and healthy fats.  Apply the 80/20 concept. Eat healthfully and calorie-consciously 80% of the time and allow for planned splurges.

Control calorie intake

Obesity experts estimate that the metabolic adaptation, or handicap, from weight loss is roughly about 15 calories for every percentage of body weight lost.   For example, if a 250 lb. person lost 50 lbs. (20% of their original weight) than they would need to take in approximately 300 less calories than someone who always weighed 200 lbs.  To compensate for the lower calorie needs, you can eat that number fewer in calories, burn the calories through exercise or do a combination of the two.  It is not known if the metabolism of persons who have lost weight adjusts over time.  In the case of the “Biggest Losers” it appears that the metabolic handicap of weight loss persisted 6 years after the initial loss.   Also, as we lose weight, there is simply less of us so we require fewer calories.  Therefore, after having lost weight we must consume substantially fewer calories than we needed for maintenance before losing weight. 

How do we effectively control calories?  Our environment is teaming with food cues and highly palatable high fat high sugar food choices.  A large percentage of the weight loss maintainers from NWCR record their intake daily.  Journaling is a way to self-monitor intake and stay accountable to yourself about your choices.  Eating similar foods day-to-day is another common behavior of NWCR’ers.  When there is less variation in the diet it is easier for to gauge an appropriate amount of intake and control portions.   Less variety also likely spurs less unplanned eating. 

Exercise, exercise, exercise!

While exercise is often not essential to lose weight, it appears that it is critical to keep off lost pounds. Therefore, it is essential to integrate physical activity into your lifestyle.  90% of NCWR participants get an average of one-hour of cardiovascular activity in six times per week.  The Dietary Guidelines for Americans advises weight loss maintainers get 60-90 minutes of moderate activity most days.  This is twice the general activity recommendation for adults.

It is also important to incorporate resistance training using weights or bands 2-3 times per week.  During weight loss, resistance activity helps to blunt muscle loss associated with weight loss.  Building muscle while in maintenance also helps to combat the metabolic slowdown associated with having lost weight. 

Watch out for TV

Sit less in front of a screen or TV.  Over two-thirds of NCWR participants watch less than 10 hours of television per week.  The average 35-49 year old American watches three times this much!  Monitor you leisure screen-time and rein it in.

Weigh yourself often

Over three-fourths of NWCR participants weigh themselves at least once per week.  Weighing yourself allows you to know when you are gaining weight and need to reevaluate your intake and lifestyle.  If you notice the weight creeping up, implement a relapse prevention plan.  For example, you might re-start measuring your portions and recording intake in a food journal.

Create a healthy environment
Make the places where you spend big chunks of time — your home, workplace, where you socialize — supportive of your healthier weight and lifestyle.  Join an exercise group.  Make activity part of your commute.  Use small plateware, utensils, and containers for your foods.  Engage family members in creating a healthy household eating environment and keep trigger foods out of the house.  Maintain a healthy respect for your own needs that allows you to prioritize the behaviors that help you be well.  The more weight-maintaining behaviors get incorporated into the backbone of your daily life the more likely you are to beat the odds and keep that lost weight off.

Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M., Walter PJ, & Hall KD. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, published online May 2, 2016 ahead of print. DOI: http://dx.doi.org /10.1002/oby.21538

Kushner, RF & Bessesen DH.  Lessons Learned From the National Weight Control Registry.  Part 2 of Treatment of the Obese Patient2007, pp 395-403.  DOI:  http://dx.doi.org/10.1007/978-1-59745-400-1_21.  Print ISBN:  978-1-58829-735-8.  Online ISBN:  978-1-59745-400-1.

Magkos  F, Fraterrigo G, Yoshino J, Luecking C, Kirbach K, Kelly SC, de las Fuentes L, He S, Okunade AL, Patterson BW Klein S. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metabolism, published online Feb. 22, 2016. DOI: http://dx.doi.org/10.1016/j.cmet.2016.02.005

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